Modern Dietary Guidelines Prioritize ‘Real Food’—But Access Remains Unequal
The federal government’s message in its new Dietary Guidelines for Americans, released in January 2026, couldn’t be simpler: “Eat real food.” However, for pregnant women in rural America, that straightforward advice runs headlong into a harsh reality: Rural women have less access to healthy whole foods.
We are public health professionals investigating how behavioral patterns throughout pregnancy affect maternal and fetal health. Our research highlights the challenges in translating national dietary recommendations into practical realities for all Americans, particularly those in rural and low-income communities.
Most Pregnant Women Aren’t Meeting Dietary Recommendations
Most pregnant women in the United States aren’t meeting dietary recommendations, and this is especially true for women living in rural communities. A recent study involving 500 pregnant women recruited from university-affiliated clinics in Pennsylvania, West Virginia, and Iowa, revealed significant disparities in dietary habits. Participants reported their dietary habits during each trimester using a questionnaire.
Approximately 20% of the participants lived in rural areas, as defined by a federal classification system. The study found that pregnant women in rural areas consumed more added sugars from sugar-sweetened beverages – about half a teaspoon more per day – compared to those in urban areas. They also consumed less fiber and fewer vegetables.
Research suggests that less healthy dietary habits may contribute to the higher rates of pregnancy complications, such as preterm birth, gestational diabetes, and hypertensive disorders, observed among rural pregnant women. Inadequate nutrition during pregnancy can also lead to long-term health issues for both mother and child, including obesity and diabetes, potentially perpetuating cycles of poor health across generations.
Poverty, Not Just Location, Drives Dietary Differences
Our study further investigated the influence of socioeconomic status on pregnant women’s diets in both rural and urban settings. We found that while rural women generally had poorer diets, socioeconomic status played a crucial role, particularly in urban areas.
In Pittsburgh, Pennsylvania, participants with a low socioeconomic status consumed 1.29 to 1.49 more teaspoons per day of added sugars from sugar-sweetened beverages and 1.5 to 1.6 grams less fiber per day than their high socioeconomic status counterparts. They also consumed 31 to 58 milligrams less calcium per day. This suggests that income and education level are strong predictors of diet quality, sometimes outweighing geographical location.
Barriers to Healthy Eating in Rural Areas
About 20% of the U.S. Population lives in rural areas. Pregnant women in these areas often face significant barriers to accessing healthy foods, including long travel distances to grocery stores offering fresh produce and whole grains. The food outlets closer to home are often convenience stores, gas stations, or dollar stores, which primarily sell processed, calorie-dense foods with lower nutritional value. Even when healthier options are available, they tend to be more expensive.
These dietary patterns are particularly concerning given the increased nutritional needs of pregnant women. Low-income and rural women are often deficient in essential nutrients such as calcium, iron, folate, and choline. Calcium, found in dairy and leafy greens, supports bone development. Iron and folate, found in beans and dark green vegetables, support the growing baby. Choline, found in eggs, beans, and nuts, assists with brain and spinal cord development.
Making ‘Eat Real Food’ Accessible
The 2025-2030 Dietary Guidelines for Americans emphasize eating whole and minimally processed foods and avoiding sugar-sweetened beverages and highly processed foods . While this advice is based on decades of research, our study highlights that following it can be more challenging for some women during pregnancy.
Pregnant women in rural and low-income communities could benefit from policies that increase access to affordable, healthy foods, such as subsidies for fresh produce or expanded supplemental nutrition assistance programs. The USDA’s Shop Simple with MyPlate tool offers practical strategies for eating well on a budget, including meal planning, avoiding impulse purchases, and utilizing a mix of fresh, frozen, and canned foods.
Choosing frozen and canned fruits and vegetables (without added salt or sugar) can be a cost-effective way to increase nutrient intake. Opting for water over sugary drinks, selecting whole grains like oatmeal and brown rice, and incorporating low-cost protein sources such as beans, lentils, and eggs can also improve diet quality and make a meaningful difference for both mom and baby.